Provider Demographics
NPI:1730425471
Name:EDEN VALLEY TELEHEALTH SERVICES
Entity type:Organization
Organization Name:EDEN VALLEY TELEHEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-273-3055
Mailing Address - Street 1:PO BOX 359
Mailing Address - Street 2:
Mailing Address - City:FARSON
Mailing Address - State:WY
Mailing Address - Zip Code:82932-0359
Mailing Address - Country:US
Mailing Address - Phone:307-273-3055
Mailing Address - Fax:307-273-3055
Practice Address - Street 1:5 HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:FARSON
Practice Address - State:WY
Practice Address - Zip Code:82932
Practice Address - Country:US
Practice Address - Phone:307-273-3055
Practice Address - Fax:307-273-3055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-28
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty